System for Monitoring and Recording Hand Hygiene Performance

ABSTRACT

A hand hygiene behavior management system capable of monitoring and recording information generated by the operation of dispensers as a method of assessing behavior of a group as an indication of overall hygiene performance. The system generally includes a plurality of wireless communication devices with a first number of the wireless communication devices being disposed within or adjacent dispensers and operatively configured for sensing, monitoring and reporting information about the status and operation of the dispensers. A hierarchal communication network for access to a central host database; a data processor and hygiene management application software operatively configured to create hygiene management reports based upon the monitored dispenser data and a method to provide user interface.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 11/784,429 filed Apr. 6, 2007, which claims the benefit of U.S.Provisional Patent Application No. 60/790,380 filed Apr. 7, 2006.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to personal hygiene. More particularly,the present invention relates to a management system for remotelymonitoring data generated by the function of a dispenser andtransmitting the monitored information to a database where theimplementation of software programs can create management informationreports documenting hand hygiene performance.

2. Prior Art

U.S. Pat. No. 6,375,038 B1 to Daansen, teaches a soap dispenser that isa teaching tool and uses audio and visual means to promote compliancewith proper washing techniques.

U.S. Pat. No. 5,945,910 to Gorra, teaches a monitoring module thatoperates in conjunction with an existing soap dispenser to track usageby individuals and provides a means of administrator review of the data.

U.S. Pat. No. 6,727,818 to Wildman, et al. describes a method ofwirelessly monitoring hygiene compliance in a healthcare environment.The method comprises the steps of receiving location information ofindividuals and objects to determine movement and hand washinginformation to determine whether a person who has entered a patientcontact zone has washed their hands since their most recent exposure toa contamination zone.

U.S. Pat. No. 5,900,801 to Heagle, et al. describes a system formonitoring and controlling a plurality of individual food establishmentmonitoring and controlling systems for a plurality of remotely located,separate food establishments. Each individual food establishment systemincludes a main computer with appropriate peripherals and an interfaceunit. The interface unit is also connected to a plurality of controldevices which both monitor and control essential activities, includingsanitation, temperature, signals for smoke detection, Ph levels,inventory and employee activities.

U.S. Pat. No. 6,426,701 to Levey, et al. teaches a system where a badgeworn by the individual indicates a hand washing requirement throughvisual or audible means. The badge is location sensitive giving promptsbased on signals received from a transmitting beacon. An individual mustwash to clear the badge alarm. Handwash performance data for individualbadge wearers are collected and stored in a database.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a block diagram of a hand hygiene monitoring system inaccordance with the present invention showing one dispenser element.

FIG. 2 is a block diagram of a hand hygiene monitoring system inaccordance with the present invention showing multiple dispenserelements in multiple locations.

FIG. 3 is a block diagram of a hand hygiene monitoring system inaccordance with the present invention showing multiple dispenserelements in multiple locations, including a wireless communication relayhub representing a number of 1 to n of possible relays.

FIG. 4 is a variation of the hand hygiene monitoring system inaccordance with the present invention where the database, data processormanagement application software, and user interface are containedlocally in close proximity to the monitored dispenser elements.

FIG. 5 shows a User Interface screen which provides functionality forthe selection of the site where hand hygiene behavior data are to beviewed and for navigation to other screens.

FIG. 6 shows a User Interface screen which provides functionality forthe selection of a hand wash quotient metric and the type of report inwhich to display the hand hygiene behavior data.

FIG. 7 shows a user interface screen which is a graphical displayrepresentation of the hand hygiene behavior.

FIG. 8 shows a user interface screen which is a tabular displayrepresentation report created as described in FIG. 6.

FIG. 9 shows an administrative user interface screen which is functionalfor the administration of variables associated with locations wherehandwash events are monitored. These locations are defined as Sites.

FIG. 10 shows an administrative user interface screen which isfunctional for the administration of variables associated with users andadministrators of the User Interface Software Application.

FIG. 11 shows an administrative user interface screen which isfunctional for the administration of variables associated with theaccess to Site data by Users of the User Interface Software Application.

FIG. 12 shows an administrative user interface screen which isfunctional for the administrative viewing of the activity of usersaccessing the User Interface Software Application.

FIG. 13 shows an administrative user interface screen which isfunctional for the administrative viewing of the handwash events ofdispenser elements monitored by the system.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The system described relates to a method for monitoring hygiene, andmore particularly hand hygiene, such as in a food, health care, generaloffice or industrial environment to determine the frequency and intervalof hand washing practices. The system described is a remote monitoringsystem capable of monitoring and recording data generated by thefunction of a soap or sanitizer dispenser and in turn creatingmanagement information reports documenting hand hygiene practicebehavior.

In recent years, the public's growing concern with disease and itstransmission has generated increased public awareness of the topic ofcleansing, and hygiene in general. Most major marketers in the cleansingand hygiene industry now believe that with increased public awarenessand education, cleansing, and especially hand cleansing, will continueto be a subject of increasing scrutiny. As a result, industries such asthe health care, food preparation, food services, and the hotel andtravel industries have been forced to examine cleansing processes,procedures, and their efficacy.

Whether it is the possible transmission of E. coli in the food servicesindustry, the rhinovirus in elementary schools, HAI diseases withinhealth care facilities, or even the ordinary contact made during asimple handshake, there are numerous studies citing effective handhygiene as the best way to guard against disease transmission. The CDChas concluded that hand washing is the single most important factor inthe prevention of disease and the spread of infection. The need for, andeffectiveness of proper hand hygiene is therefore well understood.

Non-compliance with established hand washing protocol is a seriousproblem with expensive and sometimes fatal consequences. Each year, foodborne illness strikes 76 million people, causes 325,000hospitalizations, and kills thousands. 70% of the outbreaks originate inthe food service sector. 40% of these are the result of poor handwashing and cross contamination (oral/fecal).

The CDC estimates that Hospital Acquired Infections (HAI) infectionscost on average $35,000 per incidence in extended medical costs. Withrespect to hospitals and hospital staff, it is estimated that the rateof hand washing non-compliance among health care workers is anastonishing 70-80%.

Recently verified by research at the University Of Pennsylvania SchoolOf Medicine, the CDC also estimates that the occurrence of HAI can bereduced by one-third when infection control practices that include handhygiene compliance measurement are implemented. The CDC estimates thatthe annual costs to the public health system, personal pain andsuffering, and lost productivity that result from food-borne illness andHAIs are estimated to be as high as $83 billion annually. Approximately2 million hospital patients annually become infected while being treatedfor another illness or injury. Of these 2 million infected patients,approximately 120,000 will die. The CDC estimates that these infectionsor illnesses add nearly $4.5 billion to U.S. health care costs annually.The CDC also estimates that one third of all HAI infections are causedby poor adherence to infection control practices, such as hand washing.

More specifically, in January 2004, Pennsylvania hospitals begansubmitting data on HAIs to the Pennsylvania Health Care Cost ContainmentCouncil (PHC4). While concerns remain about whether all hospitals arefully complying with this new initiative, the first year of datacollected provides stunning information for all parties involved in thedelivery and payment of hospital care. In 2004, Pennsylvania hospitalsreported 11,668 HAIs, that is, 7.5 HAIs per 1,000 patients admitted toPennsylvania's general acute care hospitals. 15.4% or 1,793 of thesepatients died. $2 billion in additional hospital charges and 205,000additional hospital days were associated with the hospital admissions inwhich these devastating infections occurred.

In a study reported in the Journal of Infectious Diseases in Children,fecal coliforms were detected on the hands of some 20 percent of thedaycare staff evaluated. Further, a third of the facilities studied hadpoor hand washing systems and no policy for hand washing before eatingor after playing outside.

The Food and Drug Administration (FDA) assists the approximately 75state and territorial agencies and more than 3,000 local departmentsthat assume primary responsibility for preventing food borne illness,and for licensing and inspecting establishments within the retailsegment of the food industry. This consists of more than one millionestablishments, and employs a work force of over 12 million. The FDAmaintains a model Food Code to assist food control jurisdictions at alllevels of government by providing them with a scientifically soundtechnical and legal basis for regulating the retail segment of the foodindustry. According to the model Food Code, a person must wash afterusing the bathroom, and defines a hand washing process with duration ofa minimum 20 seconds with concentration on the fingers and fingernails.In addition to timing the process protocol of washing including the useof soap water is defined. Many operators in commercial food service haveexpanded on the FDA model with more rigorous protocols.

The monitoring of hand washing by individuals identified with badges andassociating the badges and individuals with the use of hygienedispensers is well known in prior art. The badge based hand washmonitoring systems have experienced only minor acceptance in themarketplace due to the complexities which result from the management ofthe badges as well as the effects of personal privacy concerns caused bythe assignment of individual responsibility.

U.S. Pat. No. 6,375,038 B1 teaches a soap dispenser with a usageindicator which tracks the number of usages.

The usage indicating or so called counting dispensers have experiencedminor acceptance in the marketplace due to the burden of the manualrecording and analysis of the count data from each dispenser.

It should be noted that a typical health care or food processingfacility could have hundreds of dispensers and a similar number ofindividuals. It should also be noted that a typical food servicefacility could have only a few dispensers and the food service facilitymay be linked as a single unit to hundreds or thousands of similarfacilities in a chain association.

An improvement on the manual process of data acquisition and analysiscombined with the elimination of the individual responsibility of badgebased identification in favor of group based hygiene behaviormeasurements in the context of the aforementioned environments wherethere are a many dispensers and many individuals in distributedlocations is addressed in this disclosure.

A schematic representation of a system is shown in FIG. 1. Data aretraced from event Sensor 1 in the dispenser 2 to the LAN Gateway Hub 3,through the LAN 4 to the Data Concentrator WAN Gateway 5 to the databaseprocessor host server 6 and showing output management report and alarmsreturning to the WAN 7 and then to fixed work stations 8 or portablecommunication devices 9, such as personal computers, or personal digitalassistants communicated with a method to provide user interface.

A schematic representation of a system with multiple dispensers 2 inmultiple locations within a facility is shown in FIG. 2. and includes adata flow as previously described.

A schematic representation of a system with multiple dispensers 2 inmultiple locations within a facility including a wireless communicationrelay hub 10 representing a number of 1 to n of possible relays in thenetwork serving to transmit data over long distance from the dispensersto the WAN gateway is shown in FIG. 3 and includes a data flow aspreviously described.

The forgoing descriptions of the system for monitoring Wirelesscommunication devices teach that there is communication to a Wide AreaNetwork for access to a remote central host database, data processor andmanagement application software and a method to provide user interface.A variation of the system is shown in FIG. 4 where the database, dataprocessor management application software, and user interface arecontained in close proximity to the monitored dispensers connecteddirectly to the LAN or to the LAN wirelessly through a wireless accesspoint 11.

A representation of a method of providing the user with an interfacewith the system for the purpose of determining hand wash behaviorthrough the usage monitoring of individual dispensers is shown in FIGS.5 through 13.

FIG. 5 shows a User Interface screen which provides functionality forthe selection of the site 12 where hand wash performance data are to beviewed and for navigation 13 to other screens.

FIG. 6 shows a User Interface screen which provides functionality forthe selection of a hand wash quotient metric 14, the insertion into thedatabase of the denominator value 15 of that quotient and the creationof hand wash performance data selectable in graphical or tabular formats16. Step one in the process is to select the performance metric foravailable options examples of which are Handwashes per Employee PayrollHour, Handwashes per Meal Served, Handwashes per patient visit and Handwashes per Patent Bed Day. Step two is to enter the numerical value ofthe metric quotient denominator selected in step one and save it to thedatabase. The software application calculates the quotient of theHandwash events in the data base and the value entered. Step three is toselect the type of report to display the handwash performance data froma selection of options including graphical and tabular.

In an alternative embodiment, the denominator value and metricdefinition can be entered automatically into the calculation through aninterface with another database. For example, a financial businessmanagement software system may provide the metric quotient as payrollhours, patient days, meals cooked or customers served. A buildingmanagement software system may provide the metric value in terms oflavatory door openings, or toilet flushes.

FIG. 7 shows a user interface screen which is a graphical displayrepresentation of the number of dispense events or an associated numberof hand washes monitored by the system over a defined period of timedivided by the metric quotient denominator value entered in step two ofthe report Generation Screen described in FIG. 6 or through thealternative embodiment previously described. The Ordinate displays thequotient value calculated while the Abscissa displays the date thecalculation is effective.

FIG. 8 shows a user interface screen which is a tabular displayrepresentation report created as described in FIG. 6 previously andincludes a display of the dispense events or associated Handwashesmonitored by the system 17, the value of the metric quotient denominator18 entered in step two as described in FIG. 6 or through the alternativeembodiment previously described, the value of the quotient calculated 19and the date at which the quotient is effective 20.

FIG. 9 shows an administrative user interface screen which is functionalfor the administration of variables associated with locations wherehandwash events are monitored. These locations are defined as Sites.

FIG. 10 shows an administrative user interface screen which isfunctional for the administration of variables associated with users andadministrators of the User Interface Software Application.

FIG. 11 shows an administrative user interface screen which isfunctional for the administration of variables associated with theaccess to Site data by Users of the User Interface Software Application.

FIG. 12 shows an administrative user interface screen which isfunctional for the administrative viewing of the activity of usersaccessing the User Interface Software Application.

FIG. 13 shows an administrative user interface screen which isfunctional for the administrative viewing of the handwash events ofdispensers monitored by the system.

The system described herein is a fully integrated wireless datacollection, hierarchical network communication, telemetry, data basestorage and analysis system which combines wireless Radio Frequencycommunication technology, dispenser operation sensors, networkcommunication infrastructure, database and analysis software, managementand reporting software and a method of providing management with aninterface with the system for the purpose of determining hand washbehavior through the usage monitoring of individual dispensers.

The system is composed of a plurality of dispensers; each dispenser hasan associated wireless communication device fixed in close proximity orintegral to the dispenser such that the detection of a dispenser eventis ascribed uniquely to the dispenser. The associated wirelesscommunication device is a low power, low bandwidth radio frequencywireless communication device. Low power low bandwidth communicationcontributes to long battery life. The wireless communication device hasthe capability to broadcast information derived from the monitoreddispenser event as well as the time and a unique code identifier of thedispenser.

The multiplicity of low power low bandwidth wireless RF communicationdevices create a Personal Area Network (PAN) and communicate with ahigher power, higher bandwidth, wireless communication device and LocalArea Network (LAN) Gateway Hub which collects, sorts and relays the datagathered from all the dispensers in its reception range to a facilityLAN formed by a plurality of interconnected LAN Gateway Hubs which inturn communicate the dispenser data to a data concentrator and Wide AreaNetwork (WAN) gateway. The data concentrator stores the data forperiodic communication through the WAN gateway to the WAN as a conduit,and connects with a database data processor host data server whichfunctions as a data storage device and a software application serverwhich analyzes the status and use of the dispenser, generates managementreports and alarms and is accessible through a local or remote portablemanagement access device such as a PDA, hand held computer or fixedcomputer workstation.

It should be appreciated that a typical facility could have hundreds ofdispensers forming a Personal Area Network with multiple LAN GatewayHubs. The Gateway hubs forming a Local Area Network of Hubs whichcollect and aggregate the transmitted dispenser data and furthercommunicate the dispenser data through the LAN to a single DataConcentrator WAN Gateway. By example, a typical health care facility mayhave multiple floors with hand wash stations on each floor. Each handwash station may have multiple dispensers where data from many saiddispensers may be collected by a fewer number of LAN Gateway Hubs oneach floor. Each Hub is in communication with the other Hubs forming theLAN, collecting data from dispensers in their listening range on eachfloor and passing the aggregated data through the LAN from floor tofloor until the data reach a single Data Concentrator WAN Gateway.

Thus, the network system is distributed and hierarchical with manydispensers in distributed locations transmitting data hierarchically toa smaller number of Gateway Hubs which in turn communicate collectivelywith a single Data Concentrator and WAN Gateway.

The wireless communication devices are short range (30 to 300 feet),radio frequency (RF) radio devices designed for point to pointcommunication. The communication from point to point can be referred toas a personal Area Network (PAN). This communication can be one waycommunication or two way. One way communication reduces the complexityof network communication management and reduces the cost of individualdevices. These devices can but do not need to operate in the unlicensedIndustrial, Scientific & Medical (ISM) frequency bands. Battery power orharvested energy is the preferred method of supplying energy to thesedevices. These devices are designed to consume little power, drawingless than 10 mA when transmitting, and therefore promote long batterylife. Because the data creation rate (bandwidth) of the dispensers beingmonitored is low, the transmission rate of the transmitter is low,typically below 1 kbps. A low transmission rate consumes less power andenables a less sophisticated and less expensive microprocessor. Thevolume of data are also low which requires a small communicationtransmission duration and consumes less power for each transmission. TheRF devices suitable for use in the present invention include but are notlimited to those available from many sources. Atmel Corporation, SanJose, Calif., LINX Technologies, Grants Pass, Oreg., CypressSemiconductor, San Jose, Calif., RF Monolithics, Dallas Tex., Chipcon,Oslo, Norway. While the technology rapidly advances, Radiotronix, Moore,Okla. currently offers the preferred device in their model numberRCT-433-AS.

Wireless communication devices and LAN Gateway Hubs suitable for use inthe present invention are generally sophisticated RF transceiver deviceswith internal microprocessors. This sophisticated device is used as asingle collecting node or as a relay in a larger hierarchal network ofmany similar devices. These devices communicate in a way determined by acommunication protocol stored in the microprocessor. The protocol can bea proprietary design as demonstrated by the Zensys product or follow anindustry standard assuring interoperability as demonstrated by IEEEStandard 802.15.4 known as ZigBee or IEEE standard 802.11 known as WiFior IEEE standard 801.16 known as WiMax. This network typically extendsthe range and reliability of the sensing system by transferring the datafrom node to node in the LAN to the final device, a Data Concentratorand gateway connected to the WAN. These node devices are more expensivethan the RF transmitter discussed previously due to their complexity.They consume more power, drawing as much as 36 mA when transmitting andrequire larger batteries or mains power. They are designed to carry ahigher data Bandwidth of as much as 250 kbps. The devices are availablefrom many sources including Crossbow Technology, San Jose, Calif., Dust,Berkeley, Calif., Ember, Boston, Mass., ZMD GMBH, Dresden, Germany andLinksys, Irvine, Calif.

The WAN gateway data concentrator is a communication device which storesdata generated by the sensors and the data communicated to it by throughthe PAN to LAN network. The WAN gateway may contain a computing enginewhich processes these data to reconcile conflicting data, synthesize andformat data into a communication protocol to be communicated through theWAN to the data processor host server. The WAN gateway may be programmedfor outbound communication in the form of periodically scheduled generaldata transfers as well as asynchronous transfers in the event of specialcase alarms. The WAN gateway may be capable of bidirectionalcommunication with the data processor/server through the WAN for thepurpose of confirming that data transfers are completed with integrityor to facilitate reprogramming of the gateway from the data processorhost server. Typically the WAN gateway serves a single facility andtypically requires mains power.

It should be appreciated that the Personal Area Network (PAN) is ageneric term referring to many possible forms, implementation schemesand hybrids describing a method of connectivity to a Local Area Network(LAN). While the preferred embodiment of the PAN is unidirectional, lowpower, low bandwidth, in the unlicensed frequency bands for the purposeof the extension of battery life, connectivity can be achieved a otherradio frequencies, higher power and higher bandwidth. Bidirectionalconnectivity would allow feedback or control commands to be communicatedto the monitored dispenser.

It should be appreciated that the facility Local Area Network (LAN) is ageneric term referring to many possible forms, implementation schemesand hybrids describing a method of connectivity to a wide area network(WAN). Several typical examples of connection media are, Twisted WirePair Cable, Fiber Optic Cable, Coaxial Cable, Wireless Radio Frequencyand Power Line transmission.

It should be appreciated that the Wide Area Network (WAN) is a genericterm referring to many possible forms, implementation schemes andhybrids describing a method of connectivity to a remote database hostserver computing center. Examples of a Wide Area Network include theInternet, the wired telephone system and the wireless cell phone system.

The forgoing descriptions of the system for monitoring Wirelesscommunication devices teach that there is hierarchal networkcommunication to a Wide Area Network for access to a remote central hostdatabase, data processor and management application software and amethod to provide user interface. It should be appreciated that theinvention may be advantageously practiced using various sub-combinationsof the embodiments disclosed. A variation of the system is taught wherethe database, data processor maintenance management applicationsoftware, and user interface are contained locally in a work stationcommunicating to the LAN in close proximity to the monitored dispensers.

It should also be appreciated that another variation of the disclosedembodiment of PAN to LAN to WAN hierarchal network communicationprogression of the monitored data may be avoided in an alternateembodiment where the dispenser communicates directly to the WAN withoutfirst passing data through a LAN or WAN gateway. Examples of thisembodiment capability would include WAN communication technologyincorporated in the dispenser. Examples are the aforementioned cellulartelephone or WiMax communications devices.

Research from within several industries in which compliance with handhygiene protocol is a requirement, and where hand hygiene performance orhand hygiene compliance rates are measured as a means of management orprocess control has shown that disease, death, stresses upon the healthcare system, and enormous avoidable expense may result due tonon-compliance with minimum acceptable hand hygiene compliance rates.

Despite the fact that such a wealth of knowledge and understandingexists about the important benefits of compliance with hand hygieneprotocols; and also the fact that prior art, technologies, and productsexist which teach and provide methods for surveillance and acquisitionof discrete hygiene event data, it is evident that the measurement ofhand hygiene compliance rate as well as sustainable improvements in handhygiene performance or compliance rates continue to be elusive. As aresult, there is a significant amount of recent and ongoing researchwhich examines various efforts to achieve not only a reliable method formeasuring hand hygiene performance rates, but also achieving ameasurable, and a sustainable improvement in hand hygiene compliancerates.

A hand hygiene event is typically described as the washing of one'shands with soap and water, or the rubbing of one's hands with an ethylalcohol based hand rub or sanitizer. Both of the aforementioned handhygiene events require the use of mechanical or electro-mechanicaldispensing units which contain either liquid soap or an ethyl alcoholbased gel. When an employee or co-worker executes a hand hygiene event,the hand hygiene event necessarily requires that either soap or alcoholgel be dispensed out of the dispenser, and into the employee orco-worker's hands so that a hand hygiene event may be performed. Handhygiene events may be electronically sensed, counted and stored such asdepicted in FIGS. 1-4.

Current research, as well as the World Health Organization (WHO) suggestthat when seeking to establish or measure hand hygiene performance, itis not only the simple acquisition of discrete hygiene event data, ornumber or frequency of hand hygiene events that has occurred which mustbe measured, but more importantly, it is the number of hand hygieneevents that have occurred taken together with and per the number of handhygiene opportunities that has occurred. This more comprehensive set ofinformation is required to yield a hand hygiene rate quotient, or handhygiene compliance rate. This notion is supported by the WHO'sGuidelines on Hand Hygiene in Health Care which suggests that the handhygiene quotient or hand hygiene compliance rate should be calculatedusing the equation:

Hand Hygiene Rate=(Quantity of Hand Hygiene Events)/(Quantity of HandHygiene Opportunities)*100.

From the equation above it follows then that if an employee or co-workerhas performed hand hygiene or executed a hand hygiene event just once,when in fact there were two distinct hand hygiene opportunitiesexperienced by the employee or co-worker when hand hygiene should havebeen performed, the employee or co-worker's hand hygiene compliance ratecould be computed using the equation above and said to be equal to 50%.

It is thus evident that, given a known quantity of hand hygiene eventsthat has occurred during a given period of time, a denominator valuewhich is equal to the number of hand hygiene opportunities that has alsooccurred during the same period of time is also required in order toobtain a hand hygiene quotient or hand hygiene compliance rate.

The WHO's Guidelines on Hand Hygiene in Health Care reinforce theimportance of considering the quantity of hand hygiene events inaddition to the number of hand hygiene opportunities experienced byhealth care workers when measuring, establishing, and evaluating handhygiene performance and hand hygiene compliance rate. To support thisposition, the WHO's Guidelines on Hand Hygiene in Health Care set out todefine the five hand hygiene moments, or hand hygiene opportunities,either before or after which a health care worker should perform handhygiene. The WHO defines these five moments or opportunities as:Moment 1) Before Touching a Patient; Moment 2) Before a Clean/AsepticProcedure; Moment 3) After Body Fluid Exposure Risk; Moment 4) AfterTouching a Patient; and Moment 5) After Touching Patient Surroundings.

While there are many ways to determine the number of hand hygiene eventswhich transpire over time, within the health care community and withinhealth care facilities, the quantity of hand hygiene opportunities, suchas defined above and which has occurred over a specific period of timeis typically established via human observation. The utilization of humanobservation in determining a hand hygiene opportunity quantity requiresthat specific staff or co-workers be trained in acutely recognizing whena hand hygiene opportunity has occurred, as well as how to observeco-workers unobtrusively, or even covertly such that an accurateassessment of the number of hand hygiene opportunities which hasoccurred during an observation session may be obtained. These trainedobservers are then responsible for occasionally observing the activitiesof co-workers in their day to day activities and counting the number ofhand hygiene opportunities which occur during an occasional observationsession. Thus, a hand hygiene compliance rate may be obtained via humanobservation by taking the ratio of hand hygiene events, howeverdetermined, to observed hand hygiene opportunities. The WHO's HandHygiene Technical Reference Manual suggests that approximately 200observed hand hygiene opportunities per observation session are requiredto obtain hand hygiene compliance rates which may be reliably compared.

Thus the WHO's Guidelines on Hand Hygiene in Health Care specify amethodology for determining hand hygiene compliance rate, an equation tobe used for computing hand hygiene compliance rate which utilizes thequantity of hand hygiene events in the equation numerator and handhygiene opportunities in the equation denominator, and also provides adefinition for hand hygiene opportunities. Furthermore, the WHO's HandHygiene Technical Reference Manual establishes how human observationshould be performed in order to observe and count hand hygieneopportunities that have occurred during an observation session in orderto establish a hand hygiene opportunity value or hand hygiene complianceequation denominator value.

It follows then, that the WHO's methodology and equation for determininghand hygiene compliance rate may be applied to areas outside of healthcare where hand hygiene compliance is not only a requirement, but alsowhere a minimum hand hygiene compliance rate has been established, thenumber of discrete hand hygiene events performed by co-workers may beobserved or electronically acquired, and also where a definition of handhygiene opportunities may be established so that a hand hygiene ratedenominator value may be determined.

It should be noted that within a hospital or similar health carefacility, or even within a restaurant or food processing facility, theremay be many different work areas which, by their very nature, posevarying types of hand hygiene opportunities which would be said to betypical of said work areas. Furthermore, different work areas within thesame facility may demonstrate wide ranges in the typical quantity andfrequency of hand hygiene opportunities.

As an example, within hospitals or similar health care facilities thereare defined areas or wards that address the special and specific needstypical of various groups of the infirm. It is well known, for example,that within hospitals, the typical number of hand hygiene opportunitieswill vary dramatically by hospital ward type. Research literature pointsout that it is not uncommon to have a typical average of only eight handhygiene opportunities per patient-hour in a pediatric ward, whereas thetypical or average number of hand hygiene opportunities per patient-hourmay be as high or higher than twenty in an intensive care ward. It cantherefore be seen in the previous example, that an identical number ofdiscrete hand hygiene events in the pediatric ward and the intensivecare ward will yield completely different hand hygiene rates due to thelarge difference in typical hand hygiene opportunity value.

Utilization of the previously stated equation for determining handhygiene compliance rate, which necessarily includes the number of handhygiene opportunities, will yield a normalized hand hygiene rate whichallows the comparison of hand hygiene compliance rates against a targethand hygiene compliance rate, or comparison of hand hygiene compliancerates between co-workers regardless of disparity in the number of handhygiene opportunities characteristic of each co-worker's work area.

While globally accepted methodology for determining the hand hygienecompliance rate of individual employees or co-workers exists,historically, it has been difficult to implement in a broad and scalablefashion within large facilities or across even small groups of employeesor co-workers for a variety of reasons. For example, the humanobservation method is cost prohibitive and non-scalable over largegroups of co-workers, or across many facilities. Additionally, researchhas shown that hand hygiene performance or compliance rate resultsobtained via human observation are inaccurate due to impartiality of theobserver, and other reasons such as the well known Hawthorne Effect. Butperhaps more importantly, surveillance methods such as human observationwhich may identify and single-out discreet individuals and/or theiractivity are inherently difficult to implement due to co-workerrejection resulting from concerns about the invasion of their privacyand other related social issues. While electronic surveillance methodshave simplified the monitoring of discreet individuals, these electronicsurveillance methods do not address, and may even exacerbate co-workerconcerns over invasion of privacy. Despite these challenges, humanobservation remains the standard method for determining the quantity ofhand hygiene opportunities which has occurred over a specific period oftime.

The invention disclosed herein is an improvement over electronic hygieneevent surveillance or monitoring devices in that, although it utilizesdata-based hygiene event data which may have been electronicallyacquired, it necessarily excludes utilization of data which could beused to identify or single out individual employees or co-workers infavor of group based hygiene behavior measurements. The disclosedinvention is an improvement over existing devices because it handlesdata-based hygiene event such that the hygiene event data for groups orteams of co-workers are aggregated into a single set of hygiene eventssuch that the aggregated data is said to be the hygiene event data foran entire and specific group or team. In this way, the disclosedinvention preserves the privacy of discrete individuals while at thesame time allowing for an assessment of hand hygiene performance.

The invention disclosed herein relies on the globally accepted humanobservation method for determining the quantity of hand hygieneopportunities which have been experienced by an employee of co-workerover a specific period of time. The disclosed invention relies on thehuman observation method to determine the number of hand hygieneopportunities of one or several individuals from within a group or teamof co-workers, and then utilize the number or average number of handhygiene opportunities as representative of the number of hand hygieneopportunities typically experienced by a group or team of co-workersfrom which the observed number or average number of hand hygieneopportunities was observed. In this manner, a typical number or typicalaverage number of hand hygiene opportunities for an entire group or teamof employees or co-workers may be determined.

The disclosed invention is a system which parses data-based hygieneevent data which has been acquired from groups or teams of co-workerssuch that personal identification of individuals is excluded, aggregatesthe parsed hygiene event data into a single value for the entire group,and then utilizes an observed value or average value of hand hygieneopportunities for the group as a denominator value such that the handhygiene compliance rate for an entire group or team of co-workers may becomputed. Hand hygiene compliance, or hand hygiene performance for agroup or team of co-workers which is computed in the manner disclosedherein is said to be normalized in that, for management and processcontrol purposes, the computed hand hygiene compliance rates may becompared against target compliance rates, and comparison of hand hygienecompliance rates between semi or totally disparate groups or teams ofco-workers within large facilities is enabled.

Additional research performed by several leading authorities in the areaof hand hygiene including the University of Pennsylvania School ofMedicine, and the Columbia University School of Nursing suggests that itis not only surveillance and monitoring of hygiene activity that isnecessary to achieve a sustainable improvement in hand hygienecompliance rates of co-workers and personnel, but also that, among otherthings, frequent and unobtrusive feedback regarding measured handhygiene performance against hand hygiene performance targets must alsobe provided to personnel and co-workers. This is not surprising becauseit follows that it is difficult to define and understand the meaning ofperformance, or performance improvement without temporal context orfrequent feedback which explains how current performance compares with,or relates to expected performance.

The invention disclosed herein improves upon surveillance and monitoringhygiene data acquisition systems because not only does it provide ameans for operating upon raw hygiene data, excluding data which could beused to identify individuals, performing subsequent calculation anddetermination of a normalized hand hygiene rate quotient, and enablinghand hygiene performance or rate to be ascertained, but the disclosedinvention also provides a means for graphical rendering of thenormalized group hand hygiene compliance rate data over time, anddistribution of the rendered data over a computer network such as acorporate intranet, a private network, or the Internet. Distribution ofa graphical or similar rendering of the normalized team hand hygieneperformance or compliance rate data over a network provides a means forthe displaying of team hand hygiene performance or compliance rate dataon a plurality of network devices, such as monitors.

The pervasiveness of existing computer networks within modern facilitiesor the ease with which a new or private computer network may beestablished within any facility, such as a hospital, nursing home orfood processing facility, enables the display of real-time, or nearreal-time rendered normalized team hand hygiene performance orcompliance rate data at virtually any place within a facility asdesired. The placement of network devices such as monitors in selectareas within a facility which are frequently visited by co-workers orteam members allows co-workers or team members to see the current groupor team hand hygiene performance or compliance rate compared againsttarget compliance rates and thereby receive frequent and unobtrusivefeedback regarding the group's or team's hand hygiene performance orcompliance rate behavior. The purpose of providing frequent andunobtrusive feedback by the disclosed invention responds directly to asubstantial amount of research which has shown that frequent andunobtrusive feedback regarding hand hygiene performance must be providedto personnel in order to achieve a sustained improvement in hand hygieneperformance and hand hygiene compliance rates.

The forgoing description of the system for monitoring dispensersequipped with Wireless communication devices for the purpose ofdetermining hand hygiene performance has been presented for the purposeof illustration and description. It is not intended to be exhaustive orto limit the invention to the precise form disclosed. Many modificationsand variations are possible in light of the above teachings. Pursuant tothe above, it is to be understood that the drawings and descriptionsherein are presented by way of example to facilitate comprehension ofthe invention and should not be construed to limit the scope thereof.Accordingly, any and all modifications, variations or equivalentarrangements which may occur to those skilled in the art, should beconsidered to be within the scope of the present invention.

1. A hand hygiene rate calculation and hand hygiene performance feedbacksystem comprising a computer network with an application softwareadministration center, and application software operative on thecomputer network which allows an application software user to direct theapplication software to interface with and query data or data-bases atsites or locations on the network where raw hygiene data is produced orstored, and with an application software user interface which enablesthe application software user to enter or choose a desired hand hygienerate metric from a list of standard metrics, and to also input a handhygiene rate denominator value such that execution of the applicationsoftware will cause mathematical operations to be performed upon rawpersonnel hygiene data from locations queried as selected by theapplications software user, and utilizing the hand hygiene rate metricselected by the user and the hand hygiene rate denominator value inputby the applications software user, the system will output processed datain the form of hand hygiene performance data or hand hygiene rate data.2. The system of claim 1, wherein the application software isconfigurable via the application software administration center toaddress and interface with data-based raw hygiene data residing anywhereon the computer network that the application software is located,whether the network is a corporate intranet, a private network, or theInternet, and which raw hygiene data contains time stamped hand hygieneevent data such as the number of times and when a particular soap orsanitizer dispenser or group of particular soap or sanitizer dispensershave been used, and is stored in a publicly available database format.3. The system of claim 2, wherein the application software is configuredto perform mathematical operations on raw personnel hygiene data suchthat only the raw data required to assess the hand hygiene performanceor hand hygiene compliance rate of a group or team of co-workers orpersonnel from which the raw data originated is operated upon, and whichraw data includes time stamped soap or sanitizer dispenser usage datasuch as the number of times and when a particular soap or sanitizerdispenser or group of particular soap or sanitizer dispensers have beenused, and such that any personnel identification information and anyother information which links individual personnel identification to theraw data is necessarily excluded from mathematical operation by theapplication software.
 4. The system of claim 1, wherein the applicationsoftware is configurable via the application software administrationcenter to address and interface with data-based raw hygiene dataresiding anywhere on the computer network that the application softwareis located, whether the network is a corporate intranet, a privatenetwork, or the Internet, and where the data-base contains raw hygienedata that has been acquired by any electronic or automated personnelhygiene surveillance or monitoring system, and which raw hygiene datacontains time stamped hand hygiene event data such as the number oftimes and when a particular soap or sanitizer dispenser or group ofparticular soap or sanitizer dispensers have been used, and is stored ina publicly available database format.
 5. The system of claim 4, whereinthe application software is configured to perform mathematicaloperations on raw personnel hygiene data such that only the raw datarequired to assess the hand hygiene performance or hand hygienecompliance rate of a group or team of co-workers or personnel from whichthe raw data originated is operated upon, and which raw data includestime stamped soap or sanitizer dispenser usage data such as the numberof times and when a particular soap or sanitizer dispenser or group ofparticular soap or sanitizer dispensers have been used, and such thatany personnel identification information and any other information whichlinks individual personnel identification to the raw data is necessarilyexcluded from mathematical operation by the application software.
 6. Thesystem of claim 1, wherein the application software user interfaceincludes: a field (14) where the user inputs or selects from a list ofstandard hand hygiene performance or hand hygiene rate metrics the handhygiene performance or hand hygiene rate metrics or units which are tobe assigned to the processed and output hand hygiene performance or handhygiene rate data, and which includes at least one of the following:hand washes or hand wash events per employee hour, hand washes or handwash events per meal served, hand washes or hand wash events per averageopportunity, hand washes or hand wash events per hospital bed-day, handwashes or hand wash events per patient-hour, and hand washes or handwash events per hospital patient-day; a field (15) where a time periodis defined by the user such that only the raw hygiene data belonging tothe defined period will be operated upon, and therefore the applicationsoftware output will be hand hygiene performance data or hand hygienerate data belonging only to the defined time period; a field (15) wherea numerical denominator value having units or metrics which match thoseas chosen by the user (14) are input into the system by the user; afield (16) where the user inputs or selects from a list the desiredrendering or format of the post execution processed data output; a field(15) from within which the application software is executed such thatthe application software uses the parameters which have been selectedand input into the application software user interface, and which causesthe post execution processed data output to be saved on a networkcomputer (6).
 7. The system of claim 6, wherein the application softwareaccepts the definition of a time period with an end point in the futuresuch that the application software will automatically continue tooperate upon raw hygiene data until such future end point is reached,and so that the application software output will be hand hygieneperformance or hand hygiene rate data which is automatically andperiodically updated as new raw hygiene data becomes available.
 8. Thesystem of claim 7, wherein the application software output is handhygiene performance or hand hygiene rate data in real-time when the rawhygiene data is available in real-time.
 9. The system of claim 6,wherein when the application software has been configured by the uservia the application software user interface to use one of the standardhand hygiene metrics appearing in a list within the application softwareuser interface (14), and when the application software has beensufficiently provided with a time period and numerical denominator value(15), the execution of the application software will cause mathematicaloperations which are characteristic to the application software to occurand operate upon queried raw hygiene data such that the output of thesystem is processed hand hygiene performance, or hand hygiene rate datawhich is saved in a data-base on a network computer (6).
 10. The systemof claim 9, wherein the execution of the application software performsthe mathematical operations characteristic to the application softwareupon raw personnel hygiene data such that only the raw data required toassess the hand hygiene performance or hand hygiene compliance rate of agroup or team of co-workers or personnel from which the raw dataoriginated is operated upon, and which includes time stamped soap orsanitizer dispenser usage data such as the number of times and when aparticular soap or sanitizer dispenser or group of particular soap orsanitizer dispensers has been used, and such that any personnelidentification information and any other information which linksindividual personnel identification to the raw data is necessarilyexcluded from mathematical operation by the application software suchthat the post execution output of the application software ischaracteristic of the group or team of co-workers from which the rawdata has originated.
 11. The system of claim 10, wherein themathematical operations performed by the application software upon theraw hygiene data are mathematical or statistical analysis operations.12. The system of claim 11, wherein when the application softwareperforms the mathematical operation of division, whereby the raw hygienedata that was queried by the application software and subsequentlyparsed to exclude personnel identification information is combined intoa single value and then divided by the numerical denominator valueentered by the user (15), such that the execution of the applicationsoftware yields an output which is a hand hygiene performance or handhygiene rate quotient of the combined value in the form of a percentageor percentage decimal equivalent.
 13. The system of claim 6, whereinthat the application software user interface includes a field (16) forchoosing the output format or rendering of the processed hand hygieneperformance, or hand hygiene rate data from a list which includes agraphical and tabular rendering of output data.
 14. The system of claim13, wherein when a tabular output is selected, the system output of handhygiene performance or hand hygiene rate data is displayed in a tableand is visible via the application software user interface.
 15. Thesystem of claim 13, wherein when a graphical output is selected, thesystem output of hand hygiene performance or hand hygiene rate data areplotted over a discreet period of time (15), where the ordinate axis hasunits or metrics as entered or selected by the user via the applicationsoftware user interface (14) and the abscissa has units of time, and theresulting plot is displayed graphically and visibly via the applicationsoftware user interface.
 16. The system of claim 15, wherein thegraphical output display also includes one or two horizontal lines whichare independent of the plotted output data values and have fixed, userdefined ordinate values such that when a single horizontal line ispresent, the single horizontal line represents a user defined minimumhand hygiene performance or hand hygiene rate target value, orrepresents a user defined target hand hygiene performance or handhygiene rate value, and such that when two said horizontal lines arepresent one of the horizontal lines represents a user defined minimumhand hygiene performance or hand hygiene rate value, and the secondhorizontal line represents a user defined target hand hygieneperformance or hand hygiene rate value.
 17. The system of claim 16,wherein the horizontal lines represent user defined hand hygiene processcontrol limits such as are commonly used in statistical process controlmethods and provide a means for observing the hand hygiene performanceor hand hygiene rate data of groups or teams of co-workers as handhygiene process output data whereby the plotted hand hygiene performancedata or hand hygiene rate data of the group or team of co-workers isplotted over time, and is therefore plotted within the defined, fixedprocess control limits, or outside of the defined, fixed process controllimits.
 18. The system of claim 6, wherein the system output, such as agraphical rendering of the group or team hand hygiene performance orhand hygiene rate, is distributed to any user or computer or centralprocessing unit on the computer network (4) whether the network is acorporate intranet, a private network, or the Internet, and which hasbeen granted appropriate access and permissions via the applicationsoftware administration center.
 19. The system of claim 18, wherein anynumber of computers or display devices with central processing units aredistributed and situated such that, during their normal workdayfunctions, the computer monitors or display devices with centralprocessing units are in the frequent and periodic view of the group orteam of co-workers from which the raw hygiene data upon which theapplication software operates has originated, and such that group orteam hand hygiene performance data or data rendering is visible by thegroup or team of co-workers as hand hygiene performance or hand hygienerate feedback to the group or team of co-workers.
 20. The system ofclaim 6, wherein any of the recited fields may be populated or selectedor executed automatically and without human intervention by a secondsoftware application operating on the same computer network as thesystem of claim 6 whether the computer network is a corporate intranet,a private network, or the Internet, and which characteristically andautomatically collects such information as a part of the normal functionof said second application software.